Professional Documents
Culture Documents
01/03)
DR-3
NOTICE OF
DISSOLUTION
Comm. #
Indexed
Audited
Computer
Certified Date of Dissolution
COMMITTEE NAME
z,, COA, t. e
Official Ne of Committee
w
r Iri ~ox [~S"
Street
P -r A- 61
City, State, Zip Code
4111 6 -1 z ? y
-
Area Telephone
Code
WHEN TO FILE :
The Notice of Dissolution must be filed within thirty (30) days of completion of all the following:
For state candidates and state PACs, a final bank statement must be filed with the Notice of Dissolution or as soon as
possible if the bank statement is not available at the time the Notice of Dissolution is filed.
1 /to_ ,a L, eC.-I
Signature of Candidate or Treasurer (if candidate's committee)/Signature of Chair or Treasurer (If PAC)
lll~slo~
Date Signed